Hormonal replacement therapy (HRT) is a treatment used by an estimated 2.6 million women in the UK during the menopause to help relieve symptoms and/or strengthen bones by replacing the hormones oestrogen, often in combination with progesterone that the body no longer produces itself.
Hormonal replacement therapy (HRT) is a treatment used by an estimated 2.6 million women in the UK during the menopause to help relieve symptoms and/or strengthen bones by replacing the hormones oestrogen, often in combination with progesterone that the body no longer produces itself.
Natural and prescribed oestrogen
When oestrogen naturally declines during this life stage, it can cause a wide array of symptoms from hot flushes, night sweats, brain fog and mood changes which disrupt our daily lives, to a decline in bone mineral density or heart health which may not be apparent but have more longer-term implications to health.
However, research shows prescribed oestrogen in HRT may deplete some nutrients from the body, putting women at an increased risk of nutrient deficiency. This could translate to a wide range of signs and symptoms across the body and brain. Topping up these nutrients can help you optimise your wellbeing whilst on HRT.
Prescribed HRT comes with a patient information leaflet detailing any possible side effects. As with most medications including HRT, this doesn’t include potential nutrient deficiencies. However, research suggests HRT, or more specifically oestrogen, may deplete some nutrients which could be putting women at an increased risk of nutrient deficiency. This in itself has the potential to exacerbate some menopausal symptoms, but also a detrimental effect on other areas of health.
This might be especially relevant if eating a diet which relies heavily on ultra-processed foods as you are much less likely to fulfil your nutrient needs with diet. Effects of nutrient depletion may not be immediately obvious, mistaken for medication side-effects, or dismissed as a normal part of life, or ageing.
To date studies have linked prescribed oestrogen to potential deficiencies in vitamins C and E, folic acid and magnesium, and possibly zinc and vitamins B6, B12 too.
This is linked to the way prescribed oestrogen impacts absorption via the gut, metabolism, or excretion of nutrients by way of the liver, kidneys and gut meaning there is less availability of these nutrients for use by cells across the body and brain.
Folic Acid. Low folic acid levels can lead to fatigue, headaches, palpitations, and a higher risk of depression. Some of these like depression or low mood, fatigue and headaches are common symptoms of menopause. Folic acid is also involved in making sure our levels of homocysteine are kept in check, alongside vitamin B6 and B12, which HRT may also deplete. High homocysteine is a risk factor for reduced bone mineral density, dementia and cardiovascular disease. To help protect against these, make sure the levels of these nutrients are optimal.
Vitamin B6. Low levels of vitamin B6 can affect mood, as it is integral to making neurotransmitters such as GABA and serotonin. So, make sure you have enough vitamin B6 which is vital for balanced brain chemistry.
Vitamin B12: B12 is needed for red blood cells and in the nervous system.
Vitamin C: This key nutrient has multiple roles from collagen production, immune function, to hormone and neurotransmitter production.
Magnesium. Oestrogen in HRT increases magnesium uptake into the tissues, potentially leaving lower levels in the blood. Magnesium can help manage perimenopausal and menopause symptoms like hot flushes, fatigue, anxiety, mood swings, and sleep, whilst also improving stress resilience.
Zinc. Zinc is key in many systems including the immune system, thyroid function, bone, skin and hair. Low zinc levels could exacerbate brain fog and mood dips as it’s crucial for neurotransmitter production and cognition. Some research found low levels of zinc in the vaginal tissue of was associated with vaginal atrophy in menopause. It may also impact bone health.
Vitamin E. Oestrogen may also increase markers of oxidative stress and deplete vitamin E which it uses to quench this. Whilst vitamin E is a key antioxidant and important for skin, eye and cardiovascular health, research shows postmenopausal women supplemented with it report improvement in hot flushes.
You might be at more risk of nutrient depletion if you take other medication too. (put this in a block quote)
Medications. Other medications you may take in addition to HRT may also deplete some of the same, or different nutrients so you could be more at risk of nutrient deficiency, especially if taken longer term. Common heart and digestive medication, but also those for blood glucose management and some over the counter painkillers are ones to look out for.
To help prevent these deficiencies impacting your health, focus your diet around nutrient dense foods including nuts, seeds, leafy greens, wholegrains, fish and natural dairy products, avoiding ultra-processed foods when possible.
Try topping with the following:
Zinc: Include nuts, seeds and wholegrains regularly and fish, shellfish, and meat if you don’t exclude them.
Folic acid: Add plenty of leafy green vegetables especially spinach and broccoli, asparagus, lentils, chickpeas, butterbeans, and avocado.
Vitamin B6: Try including kidney beans, bananas, avocado, spinach, and poultry or salmon if you don’t exclude them.
Vitamin B12: This nutrient is found in animal sourced products such as poultry, meat, fish, dairy products and eggs. Nutritional yeast and some fermented vegetables may contain a small amount, supplementing with vitamin B12 will ensure a regular intake for Individuals following a vegan diet.
Magnesium: Leafy greens especially chard and spinach are packed with magnesium along with nuts especially Brazil’s, cashew and almonds, whole grains and pulses. Another food source rich in magnesium is mackerel.
Vitamin E: Regularly include a handful of nuts and seeds, but also try sweet potato, avocado, peas, spinach.
Vitamin C: This nutrient is found in abundance in vegetables and fruit but is especially rich in kiwi, strawberries, citrus fruits, peppers, and broccoli.
Your GP can test for some such as B12 or folic acid, but others are often identified by considering symptoms of deficiency when they present themselves, as mentioned earlier in this article.
If you are concerned your diet may not be providing the nutrients you need whilst on HRT taking a multivitamin and mineral part as part of your daily routine can help top up nutrient levels. You may want to take extra magnesium alongside this too, as many of us don’t get what we need from our diet due to lifestyles and available food options. Make sure you choose a supplement with no binders and fillers which contains active ingredients. For more advice about menopause and suitable supplements for you, visit your local independent health store: www.findahealthstore.com
Corin Sadler, BSc, DipION, FDSc is a Medical Herbalist and Senior Nutritionist at ethical vitamin company Viridian Nutrition. She has a Degree in Clinical Herbalism, and a Diploma and Foundation Degree in Nutritional Therapy. Corin has a wealth of clinical experience in natural health and wellbeing, and of using nutrition and herbs to optimise overall wellness.
References
Hormone Replacement Therapy - England, April 2015 to June 2024 | NHSBSA
Mohn ES, Kern HJ, Saltzman E, Mitmesser SH, McKay DL. Evidence of Drug-Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update. Pharmaceutics. 2018 Mar 20;10(1):36
Damjanovich, Peter MD; Sipos, Attila Gergely MD; Larson, Kindra MD; Cunningham, Tina D. PhD; Takacs, Peter MD, PhD, MBA; Kozma, Bence MD, PhD. Cervicovaginal lavage fluid zinc level as a marker of vaginal atrophy. Menopause 27(7):p 776-779, July 2020.
Feduniw S, Korczyńska L, Górski K, Zgliczyńska M, Bączkowska M, Byrczak M, Kociuba J, Ali M, Ciebiera M. The Effect of Vitamin E Supplementation in Postmenopausal Women-A Systematic Review. Nutrients. 2022 Dec 29;15(1):160.
Sauer AK, Hagmeyer S and Grabrucker AM (2016) Zinc Deficiency. Nutritional Deficiency. InTech. Available at: http://dx.doi.org/10.5772/63203.
Milart P, Woźniakowska E, Wrona W. Selected vitamins and quality of life in menopausal women. Prz Menopauzalny. 2018 Dec;17(4):175-179.
The information contained in this article is not intended to treat, diagnose or replace the advice of a health practitioner. Please consult a qualified health practitioner if you have a pre-existing health condition or are currently taking medication. Food supplements should not be used as a substitute for a varied and balanced diet.
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